Study On The Related Factors Affecting The Prognosis Of Patients With Laparoscopic Liver Resection Of Hepatocellular Carcinoma

Objective:Hepatocellular carcinoma(HCC)is one of the most commonly seen malignant tumors in our nation.In our nation,the amount of new increased patients of HCC and the amount of patients who died of HCC each year has reached 50 percent of the world’s total,seriously threatening people’s lives and health.Laparoscopic hepatectomy is one of the best treatment methods for HCC at present,but there are many factors affecting postoperative recurrence and death of patients and there is no clear standard,which makes the prognosis cannot be accurately predicted.Microvascular invasion(MVI)represents the malignant biological behavior of cancer and is associated with recurrence and metastasis of HCC.However,there are few studies on the prognosis of HCC patients with laparoscopic hepatectomy combined with MVI,and there is also a lack of research on preoperative prediction indicators of MVI,and there is insufficient evidence.By collecting the clinical data of HCC patients undergoing laparoscopic hepatectomy in our hospital for a period of time,this paper analyzes the influencing factors of recurrence and death,discusses the influence of MVI on the prognosis of patients undergoing laparoscopic hepatectomy,and analyzes the risk factors related to MVI.At the same time,with the increase of preoperative diagnosis of MVI,more and more HCC patients are diagnosed with MVI before surgery.It is necessary to explore the effect of different treatment methods on the prognosis of MVI-positive patients.Therefore,we collected the prognostic data of MVI-positive HCC patients undergoing open surgery at the same period to further explore the impact of surgical methods on the prognosis of MVI-positive patients.Methods:The clinical and pathological information of HCC patients(130 cases)treated by laparoscopic hepatectomy in the Affiliated Hospital of Qingdao University from January 2017 to December 2019 were collected for a retrospective study.According to whether there was MVI,the patients were divided into MVI-negative group(65 cases)and MVI-positive group(65 cases),and the prognosis of the two groups and clinical information were compared and discussed.The general information about the patient were collected,such as age,gender,alcohol consumption history,tumor diameter,tumor differentiation,liver capsule invasion,microvascular invasion,satellite lesions,liver cirrhosis,alpha-fetoprotein level,liver function related indicators,Child classification,postoperative recurrence(recurrence time,survival and survival time)and other indicators.The risk factors of recurrence and death in patients with HCC undergoing laparoscopic hepatectomy were analyzed.At the same time,the prognostic data of patients with MVI positive HCC who received open surgery in the same period were collected and compared with those of patients with MVI positive HCC who received laparoscopic surgery to analyze whether the prognosis was significantly different.Results:The recurrence-free survival(RFS)and overall survival(OS)1 and 3 years after operation in the MVI negative group were 87.3%,64.8%and 98.4%,96.6%,respectively,significantly higher than 63.2%,32.3%and 96.5%,75.2%in the MVI positive group(all P<0.05).The comparison of cliniicopathological data between the two groups showed that when the tumor diameter is larger,the level of differentiation is lower,the scale of liver capsule invasion and satellite lesions is higher,and the level of alpha-fetoprotein(AFP)and total bilirubin in preoperative patients is higher,then the possibility of MVI is likely to occur(all P<0.05).At the same time,Cox regression analysis also showed that MVI was an independent risk factor for RFS and OS of HCC patients undergoing laparoscopic hepatectomy(all P<0.05).62 patients with MVI-positive HCC who underwent open hepatectomy were collected.Compared with MVI-positive HCC patients who underwent laparoscopic hepatectomy,the RFS and OS of patients in the open group were 57.4%,37.3%and 86.9%,73.8%at 1 and 3 years after operation,respectively.The RFS and OS of the laparoscopic group were 66.2%,43.4%,96.9%,and 81.4%in 1 and 3 years,respectively.There was no significant difference between the two(P>0.05).Conclusion:The recurrence rate and mortality rate of MVI positive patients were higher than those of MVI negative patients.MVI seriously affected the prognosis of patients with HCC undergoing laparoscopic hepatectomy and was an independent risk factor for prognosis.Tumor diameter,degree of differentiation,liver capsule invasion,satellite lesion ratio,preoperative alpha-fetoprotein level and total bilirubin level may be closely related to the occurrence of microvascular invasion.There was no significant difference in the prognosis between open surgery and laparoscopic surgery in patients with MVI positive.This study provides more clinical evidence for the formulation of individualized treatment regimens and the selection of surgical methods in the treatment process,which is helpful to improve the quality of life and prolong the survival time of HCC patients,and is of great significance to promote the prognosis of the disease.